低脂血症
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2014/05/04 19:54:12」(JST)
[Wiki en表示]
Hypolipidemic agents, or antihyperlipidemic agents, are a diverse group of pharmaceuticals that are used in the treatment of hyperlipidemias. They are called lipid-lowering drugs.
Contents
- 1 Classes of hypolipidemic drugs
- 1.1 Established
- 1.2 Investigational
- 2 References
- 3 See also
Classes of hypolipidemic drugs
There are several classes of hypolipidemic drugs. They may differ in both their impact on the cholesterol profile and adverse effects. For example, some may lower the "bad cholesterol" low density lipoprotein (LDL) more so than others, while others may preferentially increase high density lipoprotein (HDL), "the good cholesterol". Clinically, the choice of an agent will depend on the patient's cholesterol profile, cardiovascular risk, and the liver and kidney functions of the patient, evaluated against the balancing of risks and benefits of the medications. In the United States, this is guided by the evidence-based guideline from the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII).
Established
- statins are particularly well-suited for lowering LDL, the cholesterol with the strongest links to vascular diseases. In studies using standard doses, statins have been found to lower LDL-C by 18% to 55%, depending on the specific statin being used. There is a risk of severe muscle damage (myopathy & rhabdomyolysis) with statins.
- fibrates are indicated for hypertriglyceridemia. Fibrates typically lower triglycerides by 20% to 50%. Level of the good cholesterol HDL is also increased. Fibrates may decrease LDL, though generally to a lesser degree than statins. Similar to statins, there is a risk of severe muscle damage (myopathy & rhabdomyolysis) with fibrates.
- niacin, like fibrates, is also well-suited for lowering triglycerides by 20–50%. It may also lower LDL by 5–25% and increase HDL by 15–35%. Niacin may cause hyperglycemia, and may also cause liver damage. The niacin derivative acipimox is also associated with a modest decrease in LDL.
- bile acid sequestrants (resins, e.g. cholestyramine) are particularly effective for lowering LDL-C by sequestering the cholesterol-containing bile acids released into the intestine and preventing their reabsorption from the intestine. It decreases LDL by 15–30% and raises HDL by 3–5%. It has little effect on triglycerides but can cause a slight increase. Bile acid sequestrants may cause gastrointestinal problems, and may also reduce the absorption of other drugs and vitamins from the gut.
- ezetimibe (Zetia) is a selective inhibitor of dietary cholesterol absorption.
- lomitapide (Juxtapid) is a microsomal triglyceride transfer protein (MTP) inhibitor.
- phytosterols may be found naturally in plants. Similar to ezetimibe, phytosterols reduce the absorption of cholesterol in the gut. Hence, they are most effective when consumed with meals. However, the precise mechanism of action of phytosterols differs from ezetimibe.
- orlistat (Xenical): Its primary function is to prevent the absorption of about 30% of fats from the human diet; thereby reducing caloric intake (a drug designed to treat obesity) is by inhibiting Pancreatic lipase- an enzyme that breaks down triglycerides in the intestine.
Investigational
Investigational classes of hypolipidemic agents:
- CETP inhibitors (cholesteryl ester transfer protein inhibitors) are still under development. It is expected that these drugs will mainly increase HDL while lowering LDL;
- Squalene synthase inhibitor;
- ApoA-1 Milano;
- AGI-1067;
- Mipomersen (completed 4 phase III trials — approved by the FDA in January 2013 for the treatment of homozygous familial hypercholesterolemia.[1][2]).
- Monoclonal antibody [3][4]
References
- ^ Pollack, Andrew (29 January 2013) F.D.A. Approves Genetic Drug to Treat Rare Disease The New York Times, Retrieved 31 January 2013
- ^ Staff (29 January 2013) FDA approves new orphan drug Kynamro to treat inherited cholesterol disorder U.S. Food and Drug Administration, Retrieved 31 January 2013
- ^ Koren MJ, Scott R, Kim JB et al Lancet 2012; 380:1995-2006
- ^ Gugliano RP, Desai NR, Kohli P et al Lancet 2012; 380:2007-17
See also
Lipid modifying agents (C10)
|
|
GI tract |
Cholesterol absorption inhibitors, NPC1L1
|
|
|
Bile acid sequestrants/resins (LDL)
|
- Cholestyramine
- Colestipol
- Colestilan
- Colextran
- Colesevelam
|
|
|
Liver |
Statins (HMG-CoA reductase, LDL)
|
- Simvastatin#
- Atorvastatin
- Fluvastatin
- Lovastatin
- Mevastatin
- Pitavastatin
- Pravastatin
- Rosuvastatin
- Cerivastatin‡
|
|
Niacin and derivatives (HDL and LDL)
|
- Niceritrol
- Niacin
- Nicofuranose
- Aluminium nicotinate
- Nicotinyl alcohol
- Acipimox
|
|
MTTP inhibitors (VLDL)
|
- Dirlotapide
- Lomitapide
- Mitratapide
|
|
|
Blood vessels |
Fibrates (PPAR)
|
- Clofibrate‡
- Bezafibrate
- Aluminium clofibrate
- Gemfibrozil
- Fenofibrate
- Simfibrate
- Ronifibrate
- Ciprofibrate
- Etofibrate
- Clofibride
- Clinofibrate
|
|
CETP inhibitors (HDL)
|
- Anacetrapib†
- Dalcetrapib§
- Evacetrapib§
- Torcetrapib†
|
|
|
Combinations |
- Niacin/lovastatin
- Niacin/simvastatin
- Ezetimibe/simvastatin
- Ezetimibe/atorvastatin
- Niacin/laropiprant
|
|
Other |
- Dextrothyroxine‡
- Probucol
- Tiadenol
- Benfluorex
- Meglutol
- Omega-3-triglycerides
- Magnesium pyridoxal 5-phosphate glutamate
- Policosanol
- Lapaquistat§
- Mipomersen
- Alipogene tiparvovec
|
|
- #WHO-EM
- ‡Withdrawn from market
- Clinical trials:
- †Phase III
- §Never to phase III
|
|
|
mt, k, c/g/r/p/y/i, f/h/s/l/o/e, a/u, n, m
|
k, cgrp/y/i, f/h/s/l/o/e, au, n, m, epon
|
m (A16/C10), i (k, c/g/r/p/y/i, f/h/s/o/e, a/u, n, m)
|
|
|
|
UpToDate Contents
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
English Journal
- Andrographolide inhibits adipogenesis of 3T3-L1 cells by suppressing C/EBPβ expression and activation.
- Chen CC1, Chuang WT2, Lin AH2, Tsai CW2, Huang CS3, Chen YT2, Chen HW4, Lii CK5.
- Toxicology and applied pharmacology.Toxicol Appl Pharmacol.2016 Sep 15;307:115-22. doi: 10.1016/j.taap.2016.07.021. Epub 2016 Jul 27.
- Andrographolide, a diterpenoid, is the most abundant terpenoid in Andrographis paniculata, a popular Chinese herbal medicine. Andrographolide displays diverse biological activities including hypoglycemia, hypolipidemia, anti-inflammation, and anti-tumorigenesis. Recent evidence indicates that androg
- PMID 27475717
- Structure-function analyses of microsomal triglyceride transfer protein missense mutations in abetalipoproteinemia and hypobetalipoproteinemia subjects.
- Walsh MT1, Di Leo E2, Okur I3, Tarugi P2, Hussain MM4.
- Biochimica et biophysica acta.Biochim Biophys Acta.2016 Jul 31;1861(11):1623-1633. doi: 10.1016/j.bbalip.2016.07.015. [Epub ahead of print]
- We describe two new hypolipidemic patients with very low plasma triglyceride and apolipoprotein B (apoB) levels with plasma lipid profiles similar to abetalipoproteinemia (ABL) patients. In these patients, we identified two previously uncharacterized missense mutations in the microsomal triglyceride
- PMID 27487388
- Hypolipidemic mechanism of oryzanol components- ferulic acid and phytosterols.
- Bhaskaragoud G1, Rajath S1, Mahendra VP2, Kumar GS1, Gopala Krishna AG1, Kumar GS3.
- Biochemical and biophysical research communications.Biochem Biophys Res Commun.2016 Jul 22;476(2):82-9. doi: 10.1016/j.bbrc.2016.05.053. Epub 2016 May 12.
- The effect of oryzanol (well known hypolipidemic component in rice bran oil) and its chemical constituents- ferulic acid (FA) and phytosterols on hypolipidemia were investigated.METHODS AND RESULTS: Docking (in silico) studies showed that FA had a better binding ability with lipase while sterols bou
- PMID 27179780
Japanese Journal
- 症例報告 アルコール性肝炎,肝不全との鑑別を要したkwashiorkor型栄養障害の1例
- アルコール性肝炎,肝不全との鑑別を要したkwashiorkor型栄養障害の1例
- 松村 真生子,小林 奈津子,田代 興一,太島 丈洋,田中 忍,小島 英吾
- 肝臓 54(3), 178-186, 2013
- 症例は54歳男性.1年前に失業してからアルコールを多飲し,不適切な食生活を続けていた.2010年11月某日に自宅で倒れているのを発見され搬送された.主たる病態について,アルコール性肝炎・肝不全との鑑別に悩んだが,入院時の臨床症状,各種データよりkwashiorkor型栄養障害と診断した.来院時は重篤な状態であったが,蛋白補給に配慮した栄養管理を行い,42日目に独歩で退院された. 低栄養状態の重症型 …
- NAID 130003368667
- Castleman's Disease Accompanied by Hypolipidemic Cerebral Hemorrhage and Nephrosclerosis
- Imafuku Aya,Suwabe Tatsuya,Hasegawa Eiko,Mise Koki,Sumida Keiichi,Hiramatsu Rikako,Yamanouchi Masayuki,Hayami Noriko,Hoshino Junichi,Sawa Naoki,Oohashi Kenichi,Fujii Takashi,Okubo Minoru,Takaichi Kenmei,Oga Tatsuhide,Ubara Yoshifumi
- Internal Medicine 52(14), 1611-1616, 2013
- A 56-year-old Japanese man developed a cerebral hemorrhage and was diagnosed with plasma cell-type multicentric Castleman's disease (MCD) based on the findings of an inguinal lymph node biopsy in addi …
- NAID 130003365708
Related Links
- Definition of hypolipidemia in the Medical Dictionary. hypolipidemia explanation. Information about hypolipidemia in Free online English dictionary. What is hypolipidemia? Meaning of hypolipidemia medical term. What does ...
- Learn about Hypolipidemia symptoms, diagnosis and treatment in the Merck Manual. See Home and Vet versions too! ... Hypolipidemia is a decrease in plasma lipoprotein caused by primary (genetic) or secondary factors. It is ...
Related Pictures